{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,7,2]],"date-time":"2026-07-02T23:53:41Z","timestamp":1783036421603,"version":"3.54.6"},"reference-count":24,"publisher":"Springer Science and Business Media LLC","issue":"1","license":[{"start":{"date-parts":[[2021,5,8]],"date-time":"2021-05-08T00:00:00Z","timestamp":1620432000000},"content-version":"tdm","delay-in-days":0,"URL":"http:\/\/creativecommons.org\/licenses\/by\/4.0\/"},{"start":{"date-parts":[[2021,5,8]],"date-time":"2021-05-08T00:00:00Z","timestamp":1620432000000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":["link.springer.com"],"crossmark-restriction":false},"short-container-title":["BMC Gastroenterol"],"published-print":{"date-parts":[[2021,12]]},"abstract":"<jats:title>Abstract<\/jats:title><jats:sec>\n                <jats:title>Background<\/jats:title>\n                <jats:p>Systemic lupus erythematosus (SLE) is a multisystemic autoimmune disease, and few cases combine with Crohn\u2019s disease. We present the first SLE patient concurrent with Crohn\u2019s disease and rectovaginal fistula. She was successfully treated with vedolizumab and surgical intervention. Besides, she also had a rare opportunistic infection, cryptococcal pneumonia, in previous adalimumab treatment course.<\/jats:p>\n              <\/jats:sec><jats:sec>\n                <jats:title>Case<\/jats:title>\n                <jats:p>A 57\u00a0year-old female had SLE in disease remission for 27\u00a0years. She suffered from progressive rectal ulcers with anal pain and bloody stool, and Crohn\u2019s disease was diagnosed. She received adalimumab, but the lesion still progressed to a rectovaginal fistula. Besides, she suffered from an episode of cryptococcal pneumonia under adalimumab treatment course. Therefore, we changed the biologics to vedolizumab, and arrange a transverse colostomy for stool diversion. She had clinical remission without active inflammation, but the fistula still persisted. Then, she received a restorative proctectomy with colo-anal anastomosis and vaginal repair. Follow-up endoscopy showed no more rectal ulcers or fistula tracts, and contrast enema also noted no residual rectovaginal fistula.<\/jats:p>\n              <\/jats:sec><jats:sec>\n                <jats:title>Conclusion<\/jats:title>\n                <jats:p>When a SLE patient had unusual rectal ulcers, Crohn\u2019s disease should be considered. Biologics combined with surgical intervention is an optimal solution for Crohn\u2019s disease with rectovaginal fistula. Although cryptococcal pneumonia is a rare opportunistic infection in the biological treatment, we should always keep it in mind.<\/jats:p>\n              <\/jats:sec>","DOI":"10.1186\/s12876-021-01801-w","type":"journal-article","created":{"date-parts":[[2021,5,8]],"date-time":"2021-05-08T09:03:07Z","timestamp":1620464587000},"update-policy":"https:\/\/doi.org\/10.1007\/springer_crossmark_policy","source":"Crossref","is-referenced-by-count":8,"title":["Systemic lupus erythematosus complicated by Crohn\u2019s disease with rectovaginal fistula"],"prefix":"10.1186","volume":"21","author":[{"given":"Heng","family":"Yeh","sequence":"first","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Ren-Chin","family":"Wu","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Wen-Sy","family":"Tsai","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Chia-Jung","family":"Kuo","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Ming-Yao","family":"Su","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Cheng-Tang","family":"Chiu","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-1100-5371","authenticated-orcid":false,"given":"Puo-Hsien","family":"Le","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"297","published-online":{"date-parts":[[2021,5,8]]},"reference":[{"key":"1801_CR1","doi-asserted-by":"publisher","first-page":"6","DOI":"10.1186\/1750-1172-1-6","volume":"1","author":"JJ Manson","year":"2006","unstructured":"Manson JJ, Rahman A. Systemic lupus erythematosus. Orphanet J Rare Dis. 2006;1:6.","journal-title":"Orphanet J Rare Dis"},{"issue":"9","key":"1801_CR2","doi-asserted-by":"publisher","first-page":"960","DOI":"10.1016\/j.crohns.2012.05.017","volume":"6","author":"KH Katsanos","year":"2012","unstructured":"Katsanos KH, Tsianos VE, Tsianos EV. Intolerance of folic acid in a patient receiving methotrexate for Crohn\u2019s disease. J Crohns Colitis. 2012;6(9):960.","journal-title":"J Crohns Colitis"},{"issue":"9","key":"1801_CR3","doi-asserted-by":"publisher","first-page":"1256","DOI":"10.1097\/MEG.0000000000001775","volume":"32","author":"X Jin","year":"2020","unstructured":"Jin X, Wang G, Xu X, Bai Y, An R, Jiang D. Coexistence of Crohn\u2019s disease and systemic lupus erythematosus: a case report and literature review. Eur J Gastroenterol Hepatol. 2020;32(9):1256\u201362.","journal-title":"Eur J Gastroenterol Hepatol"},{"key":"1801_CR4","doi-asserted-by":"publisher","first-page":"174","DOI":"10.1186\/1471-230X-12-174","volume":"12","author":"H Yamashita","year":"2012","unstructured":"Yamashita H, Ueda Y, Kawaguchi H, Suzuki A, Takahashi Y, Kaneko H, et al. Systemic lupus erythematosus complicated by Crohn\u2019s disease: a case report and literature review. BMC Gastroenterol. 2012;12:174.","journal-title":"BMC Gastroenterol"},{"issue":"1","key":"1801_CR5","doi-asserted-by":"publisher","first-page":"58","DOI":"10.1007\/BF01318372","volume":"30","author":"BI Korelitz","year":"1985","unstructured":"Korelitz BI, Present DH. Favorable effect of 6-mercaptopurine on fistulae of Crohn\u2019s disease. Dig Dis Sci. 1985;30(1):58\u201364.","journal-title":"Dig Dis Sci"},{"issue":"9","key":"1801_CR6","doi-asserted-by":"publisher","first-page":"714","DOI":"10.1097\/MCG.0000000000000607","volume":"50","author":"P Kaimakliotis","year":"2016","unstructured":"Kaimakliotis P, Simillis C, Harbord M, Kontovounisios C, Rasheed S, Tekkis PP. A systematic review assessing medical treatment for rectovaginal and enterovesical fistulae in Crohn's disease. J Clin Gastroenterol. 2016;50(9):714\u201321.","journal-title":"J Clin Gastroenterol."},{"issue":"10","key":"1801_CR7","doi-asserted-by":"publisher","first-page":"912","DOI":"10.1016\/S1542-3565(04)00414-8","volume":"2","author":"BE Sands","year":"2004","unstructured":"Sands BE, Blank MA, Patel K, van Deventer SJ. Long-term treatment of rectovaginal fistulas in Crohn\u2019s disease: response to infliximab in the ACCENT II Study. Clin Gastroenterol Hepatol. 2004;2(10):912\u201320.","journal-title":"Clin Gastroenterol Hepatol"},{"issue":"1","key":"1801_CR8","doi-asserted-by":"publisher","first-page":"8","DOI":"10.1097\/00054725-200501000-00002","volume":"11","author":"Y Gonz\u00e1lez-Lama","year":"2005","unstructured":"Gonz\u00e1lez-Lama Y, Abreu L, Vera MI, Pastrana M, Tabernero S, Revilla J, et al. Long-term oral tacrolimus therapy in refractory to infliximab fistulizing Crohn\u2019s disease: a pilot study. Inflamm Bowel Dis. 2005;11(1):8\u201315.","journal-title":"Inflamm Bowel Dis"},{"issue":"5","key":"1801_CR9","doi-asserted-by":"publisher","first-page":"621","DOI":"10.1093\/ecco-jcc\/jjy019","volume":"12","author":"BG Feagan","year":"2018","unstructured":"Feagan BG, Schwartz D, Danese S, Rubin DT, Lissoos TW, Xu J, et al. Efficacy of vedolizumab in fistulising crohn\u2019s disease: exploratory analyses of data from GEMINI 2. J Crohns Colitis. 2018;12(5):621\u20136.","journal-title":"J Crohns Colitis"},{"issue":"1","key":"1801_CR10","doi-asserted-by":"publisher","first-page":"e11","DOI":"10.1016\/j.crohns.2012.04.016","volume":"7","author":"JB Fraison","year":"2013","unstructured":"Fraison JB, Guilpain P, Schiffmann A, Veyrac M, Le Moing V, Rispail P, et al. Pulmonary cryptococcosis in a patient with Crohn\u2019s disease treated with prednisone, azathioprine and adalimumab: exposure to chicken manure as a source of contamination. J Crohns Colitis. 2013;7(1):e11\u20134.","journal-title":"J Crohns Colitis"},{"issue":"4","key":"1801_CR11","doi-asserted-by":"publisher","first-page":"747","DOI":"10.1016\/S0889-8553(05)70032-7","volume":"27","author":"M Bailey","year":"1998","unstructured":"Bailey M, Chapin W, Licht H, Reynolds JC. The effects of vasculitis on the gastrointestinal tract and liver. Gastroenterol Clin N Am. 1998;27(4):747\u201382.","journal-title":"Gastroenterol Clin N Am."},{"issue":"10","key":"1801_CR12","doi-asserted-by":"publisher","first-page":"917","DOI":"10.1093\/rheumatology\/38.10.917","volume":"38","author":"SM Sultan","year":"1999","unstructured":"Sultan SM, Ioannou Y, Isenberg DA. A review of gastrointestinal manifestations of systemic lupus erythematosus. Rheumatology (Oxf). 1999;38(10):917\u201332.","journal-title":"Rheumatology (Oxf.)"},{"issue":"5","key":"1801_CR13","doi-asserted-by":"publisher","first-page":"299","DOI":"10.4166\/kjg.2019.73.5.299","volume":"73","author":"KC Sohn","year":"2019","unstructured":"Sohn KC, Heo WG, Chu MS, Kim EJ, Chung JH, Choi SC, et al. Rectal ulcer developed in systemic lupus erythematosus without ischemic colitis. Korean J Gastroenterol. 2019;73(5):299\u2013302.","journal-title":"Korean J Gastroenterol"},{"issue":"2","key":"1801_CR14","doi-asserted-by":"publisher","first-page":"357","DOI":"10.3109\/14397595.2013.852846","volume":"24","author":"S Kaieda","year":"2014","unstructured":"Kaieda S, Kobayashi T, Moroki M, Honda S, Yuge K, Kawano H, et al. Successful treatment of rectal ulcers in a patient with systemic lupus erythematosus using corticosteroids and tacrolimus. Mod Rheumatol. 2014;24(2):357\u201360.","journal-title":"Mod Rheumatol"},{"key":"1801_CR15","doi-asserted-by":"publisher","unstructured":"Yau AH, Chu K, Yang HM, Ko HH. Rectal ulcers induced by systemic lupus erythematosus. BMJ Case Rep. 2014;bcr2014205776. https:\/\/doi.org\/10.1136\/bcr-2014-205776.","DOI":"10.1136\/bcr-2014-205776."},{"issue":"8","key":"1801_CR16","doi-asserted-by":"publisher","first-page":"643","DOI":"10.2169\/internalmedicine.38.643","volume":"38","author":"J Teramoto","year":"1999","unstructured":"Teramoto J, Takahashi Y, Katsuki S, Sato T, Sakamaki S, Kobayashi D, et al. Systemic lupus erythematosus with a giant rectal ulcer and perforation. Intern Med. 1999;38(8):643\u20139.","journal-title":"Intern Med"},{"issue":"3","key":"1801_CR17","first-page":"407","volume":"20","author":"S Yuasa","year":"2002","unstructured":"Yuasa S, Suwa A, Hirakata M, Hibi N, Iwao Y, Koizumi K, et al. A case of systemic lupus erythematosus presenting with rectal ulcers as the initial clinical manifestation of disease. Clin Exp Rheumatol. 2002;20(3):407\u201310.","journal-title":"Clin Exp Rheumatol"},{"issue":"3","key":"1801_CR18","doi-asserted-by":"publisher","first-page":"334","DOI":"10.1177\/0961203319897130","volume":"29","author":"Z Wang","year":"2020","unstructured":"Wang Z, Wu C, Ruan F, Li Z, Peng X, Wang P. A case of systemic lupus erythematosus with rectal necrosis. Lupus. 2020;29(3):334\u20139.","journal-title":"Lupus"},{"issue":"4","key":"1801_CR19","doi-asserted-by":"publisher","first-page":"1116","DOI":"10.1111\/j.1572-0241.2001.03756.x","volume":"96","author":"CN Bernstein","year":"2001","unstructured":"Bernstein CN, Blanchard JF, Rawsthorne P, Yu N. The prevalence of extraintestinal diseases in inflammatory bowel disease: a population-based study. Am J Gastroenterol. 2001;96(4):1116\u201322.","journal-title":"Am J Gastroenterol"},{"issue":"8","key":"1801_CR20","doi-asserted-by":"publisher","first-page":"1982","DOI":"10.1097\/MIB.0000000000000392","volume":"21","author":"SR Vavricka","year":"2015","unstructured":"Vavricka SR, Schoepfer A, Scharl M, Lakatos PL, Navarini A, Rogler G. Extraintestinal manifestations of inflammatory bowel disease. Inflamm Bowel Dis. 2015;21(8):1982\u201392.","journal-title":"Inflamm Bowel Dis"},{"issue":"3","key":"1801_CR21","doi-asserted-by":"publisher","first-page":"827","DOI":"10.1053\/j.gastro.2005.06.021","volume":"129","author":"CN Bernstein","year":"2005","unstructured":"Bernstein CN, Wajda A, Blanchard JF. The clustering of other chronic inflammatory diseases in inflammatory bowel disease: a population-based study. Gastroenterology. 2005;129(3):827\u201336.","journal-title":"Gastroenterology"},{"issue":"3","key":"1801_CR22","doi-asserted-by":"publisher","first-page":"219","DOI":"10.1080\/14740338.2019.1577817","volume":"18","author":"G Murdaca","year":"2019","unstructured":"Murdaca G, Negrini S, Pellecchio M, Greco M, Schiavi C, Giusti F, et al. Update upon the infection risk in patients receiving TNF alpha inhibitors. Expert Opin Drug Saf. 2019;18(3):219\u201329.","journal-title":"Expert Opin Drug Saf"},{"issue":"4","key":"1801_CR23","doi-asserted-by":"publisher","first-page":"524","DOI":"10.5217\/ir.2017.15.4.524","volume":"15","author":"WS Lee","year":"2017","unstructured":"Lee WS, Azmi N, Ng RT, Ong SY, Ponnampalavanar SS, Mahadeva S, et al. Fatal infections in older patients with inflammatory bowel disease on anti-tumor necrosis factor therapy. Intest Res. 2017;15(4):524\u20138.","journal-title":"Intest Res"},{"issue":"3","key":"1801_CR24","doi-asserted-by":"publisher","first-page":"276","DOI":"10.1016\/j.crohns.2011.08.015","volume":"6","author":"G de la Poza","year":"2012","unstructured":"de la Poza G, Lopez-Sanroman A, Taxonera C, Marin-Jimenez I, Gisbert JP, Bermejo F, et al. Genital fistulas in female Crohn\u2019s disease patients: clinical characteristics and response to therapy. J Crohns Colitis. 2012;6(3):276\u201380.","journal-title":"J Crohns Colitis"}],"container-title":["BMC Gastroenterology"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/link.springer.com\/content\/pdf\/10.1186\/s12876-021-01801-w.pdf","content-type":"application\/pdf","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/link.springer.com\/article\/10.1186\/s12876-021-01801-w\/fulltext.html","content-type":"text\/html","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/link.springer.com\/content\/pdf\/10.1186\/s12876-021-01801-w.pdf","content-type":"application\/pdf","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2021,5,8]],"date-time":"2021-05-08T09:04:27Z","timestamp":1620464667000},"score":1,"resource":{"primary":{"URL":"https:\/\/bmcgastroenterol.biomedcentral.com\/articles\/10.1186\/s12876-021-01801-w"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2021,5,8]]},"references-count":24,"journal-issue":{"issue":"1","published-print":{"date-parts":[[2021,12]]}},"alternative-id":["1801"],"URL":"https:\/\/doi.org\/10.1186\/s12876-021-01801-w","relation":{},"ISSN":["1471-230X"],"issn-type":[{"value":"1471-230X","type":"electronic"}],"subject":[],"published":{"date-parts":[[2021,5,8]]},"assertion":[{"value":"17 September 2020","order":1,"name":"received","label":"Received","group":{"name":"ArticleHistory","label":"Article History"}},{"value":"3 May 2021","order":2,"name":"accepted","label":"Accepted","group":{"name":"ArticleHistory","label":"Article History"}},{"value":"8 May 2021","order":3,"name":"first_online","label":"First Online","group":{"name":"ArticleHistory","label":"Article History"}},{"order":1,"name":"Ethics","group":{"name":"EthicsHeading","label":"Declarations"}},{"value":"The written informed consent to participate was obtained.","order":2,"name":"Ethics","group":{"name":"EthicsHeading","label":"Ethics approval and consent to participate"}},{"value":"Written consent was obtained from the participant for publication.","order":3,"name":"Ethics","group":{"name":"EthicsHeading","label":"Consent for publication"}},{"value":"The authors declare that they have no competing interests.","order":4,"name":"Ethics","group":{"name":"EthicsHeading","label":"Competing interests"}}],"article-number":"206"}}